Ep. 147: Reading Is Health: The Case for Early Literacy (Part 1 of 2)

Early literacy is one of the strongest indicators of lifelong health and success – yet reading scores across the U.S. are declining at an alarming rate. In part one of this two-part series, we dive into what the latest data reveals, how the COVID-19 pandemic has intensified the literacy crisis, and what actions educators and health care providers can take to reverse these trends.

Celebrating its 20th anniversary, Nemours Children’s Reading BrightStart! continues its mission to help every child become a successful reader through early literacy curricula, educator training and family resources for children from birth to first grade.

Resources:
Nemours Children’s Reading BrightStart! Family Resources
Harris Poll Executive Summary
Full Harris Poll Results

Guests:
Kate Blackburn, MSW, Director of Practice and Prevention, National Office of Policy & Prevention, Nemours Children’s Health

Rebeca Grysko, PhD, CBIS, Special Education Teacher and School Liaison, Nemours Children’s Hospital, Florida

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Announcer:

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast produced by Nemours Children's Health. Subscribe on any platform at Nemourswellbeyond.org or find us on YouTube.

Carol Vassar, podcast host/producer:

Each week we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you are here, let's go. 

Believe it or not, the school year is just around the corner. So we are here to talk about not arithmetic, not writing, but reading. This is the first of a two-part edition of the Nemours Well Beyond Medicine podcast, celebrating the 20th anniversary of a science-based program that was developed to promote early literacy and reading readiness for children from birth to age five. That program is Nemours Children's Reading Bright Start. Launched in 2005, it's designed to address one of the most powerful predictions of lifelong health, and that is literacy. 

In this episode of the podcast, we'll explore the connection between reading and well-being, uncover some insights from a national Harris Poll of teachers on the topic of literacy, and set the stage for why literacy needs urgent and coordinated action. Joining me for this episode are Kate Blackburn, Director of National Practice and Prevention at Nemours Children's Health and Dr. Rebecca Grysko, Becca, a special education teacher and school liaison at Nemours Children's Hospital in Florida. We started our conversation at a very high level to help establish the state of childhood literacy in the U.S. today and the why behind commissioning a Harris Poll survey on early literacy. Here's Kate Blackburn.

Kate Blackburn, Nemours Children's Health:

So I'll give you our why for commissioning, the Harris Poll, and a couple of big headlines. First, research shows a strong link between literacy and lifelong learning. Second, recognizing the link, Nemours Children's Health has been leading and evaluating interventions to improve early literacy for 20 years, as you noted, with a focus on children in preschool and kindergarten. So we care deeply about this issue. Third, in terms of our why, the nation's report card got a lot of media attention earlier this year because it spotlighted the concerning downward trend in reading scores across the U.S. that began prior even to the COVID-19 pandemic. And so, if all of these things are in mind, we commission the Harris Poll survey and are sharing those findings with the public to shed light on the ways that Nemours Children's and other literacy champions can intervene. And to that end, I'm excited for us to have some of our community early education partners with us today, who will be featured in the second half of the episode, and some of our in-house early literacy experts. Then, together, they can describe what it looks like when healthcare and the education sector collaborate to improve early literacy.

Carol Vassar, podcast host/producer:

One of those in-house early literacy experts is Becca Grysko. You're a leader of the hospital-based school at Nemours in Orlando. Give us a bit of a snapshot of the current state of early literacy in the U.S. Kate was pointing to a kind of a grim picture here. How are kids doing now? How were they doing before COVID, and how are they doing now after COVID?

Dr. Rebeca Grysko, Nemours Children's Health:

Absolutely, Carol. That is true. The state of early literacy in the US has faced significant challenges, especially in the wake of the COVID-19 pandemic. Unfortunately, America's children are continuing to fall behind in reading. The National Assessment of Educational Progress is the largest annual and nationally representative assessment of reading skills among America's fourth and eighth-grade students. The 2024 National Assessment of Educational Progress found that about 67% of fourth graders are not reading at grade level. Though this is a slight improvement from 2023, it's still significantly below pre-pandemic levels. Because of that strong link between literacy and lifelong health, Nemours Children's is working with other stakeholders to track and improve reading assessment scores among third-graders and kindergartners in our service areas.

Carol Vassar, podcast host/producer:

You mentioned fourth grade. I know that third grade, kind of fourth grade point in a child's education, is really something that matters when it comes to looking at statistics, looking at milestones. Why does that third-grade or fourth-grade reading matter so much?

Dr. Rebeca Grysko, Nemours Children's Health:

Third grade marks the transition point where children move from learning to read to reading to learn. If a child is not proficient by this stage, they may struggle significantly in later grades and face challenges with academic success throughout their education. From state to state, there really isn't a standard assessment for third-grade reading. However, data from Delaware and Florida, where our two hospitals are located, demonstrate the same downward trends. In Delaware, just 39% of third-graders scored at the proficient range on the state's English language assessment in 2024, which is down from 54% in 2015. And then in Florida, only 53% of third-graders achieved a passing grade on the English language arts portion of the Florida Standards Assessment in 2022, which is down from 58% in 2017.

Carol Vassar, podcast host/producer:

Let's back that up a little bit. When a child goes to kindergarten, at least back in my day, when you went to kindergarten, you weren't expected to read. What are some of the trends when kids go to kindergarten that we are looking at or looking for when it comes to early literacy, Becca?

Dr. Rebeca Grysko, Nemours Children's Health:

Again, from state to state, there isn't a standard assessment for reading-related skills among kindergartners, but data from Delaware and Florida show negative trends. The Delaware Early Learner Survey is an observational tool through which kindergarten teachers observe students' skills and knowledge on six developmental domains within the first 30 days of kindergarten. In the literacy domain, 80% of Delaware's kindergarten students were proficient as of 2023. That's down from 85% in 2020. In Florida, kindergarten school readiness, which includes literacy domains but isn't exclusively focused on literacy, fell from 54% in 2018 to 51% in 2024. It is important to note, Carol, that 64% of children who attended free, publicly available, half-day, voluntary pre-K programs in Florida did meet the ready-for-kindergarten score threshold as opposed to just 36% of children who did not participate. This finding is so incredibly important as it shows the importance of pre-K in setting children up for reading success in kindergarten and beyond.

Carol Vassar, podcast host/producer:

You talked about literacy domains. Talk a little bit about that, and what should I, as a parent and now a grandparent, be looking for to know that my child is ready for kindergarten, or maybe not in the literacy realm?

Dr. Rebeca Grysko, Nemours Children's Health:

When it comes to literacy, getting ready for kindergarten, we want children to have an awareness of letter names and sounds. We want children to start showing interest in books. We really build that by reading with children in the home. It starts with their parents exposing them to books, concepts about print, getting them excited to read, and just showing an excitement about books and reading with others.

Carol Vassar, podcast host/producer:

And grandparents can play a big role in that. Even though my granddaughter lives in Florida and I'm in Connecticut, I read to her on our weekly calls. So it's a very important thing that I've learned from my parents, passed on to my daughter, and now to my granddaughter. I want to play this forward a little bit. Let's look at the long-term impact on our country if today's children, who are tomorrow's adults, grow up with low literacy skills, Becca.

Dr. Rebeca Grysko, Nemours Children's Health:

The impact of low literacy among today's children extends far beyond the classroom. It's really a national issue with deep and lasting consequences for our economy, our health systems, and really the very fabric of our democracy. 21% of U.S. adults, that's 43 million people, have low literacy skills, meaning that they may be unable to successfully read and comprehend basic text or even fill out simple forms such as medical forms or job applications. We need to prevent these figures from increasing. Low adult literacy has wide-ranging negative consequences affecting individuals, communities, as well as the broader economy.

These consequences include reduced employment and income opportunities, limited access to healthcare and information, poor health outcomes, as well as the potential intergenerational cycles of disadvantage. It has been estimated that low rates of literacy among American adults could cause a loss of up to $200 billion in terms of healthcare costs as well as a loss of $1.4 trillion in gross domestic product. So the overall takeaway is this: given that low literacy rates are linked to less favorable lifelong health outcomes and staggering impacts on healthcare costs and the U.S. economy, the downward trend in reading scores presents a true call to action.

Carol Vassar, podcast host/producer:

As I'm listening to you, Becca, what I'm hearing is, and we do a lot of shows about health literacy, but if somebody doesn't have the basic literacy skills to understand what the doctor is telling them or to discern what is correct health information, that can be life-altering, life-threatening even, which is very much a concern. At this point, I want to look at the Harris Poll. It was recently commissioned by Nemours Children's to explore teacher perspectives on early literacy, and it's one aspect of Nemours responding to that call to action that you were talking about, Becca. Let's talk more about the survey. Kate, I'm going to turn to you. What did the poll cover?

Kate Blackburn, Nemours Children's Health:

We designed the poll to explore four topics. So, first was the ways that students in kindergarten through third grade are struggling with literacy. What does that look like? How does that manifest in the classroom? Second, the extent to which teachers have curricula and other resources that they need to support struggling readers. Third was the extent to which teachers have resources to share with families to support literacy-building activities at home. And fourth is teachers' perceptions of what parents are doing in the home to improve their child's literacy. This survey gathered insights from just over 300 full-time teachers covering from kindergarten through third grade.

Carol Vassar, podcast host/producer:

What were some of the highlights? That's what you were looking to find out. What were the major findings? What were the highlights, Kate?

Kate Blackburn, Nemours Children's Health:

Well, I think the headline is this. Teachers recognize that there's a literacy crisis, but they don't feel like they have the tools or necessarily the training that they need to address it, and that's why we're glad to have educators with us today to explain how that looks in real life. 84% of the teachers that responded to the survey said that they're concerned about the reading skills of students when they enter their classrooms, so K through third grade. And then there were a couple of buckets there. So in terms of the training and tools that they need to help build literacy skills among their students, the responses really highlighted some significant opportunities. Only 26% reported being highly satisfied with the literacy tools that they have in their classrooms to use. 41% reported that the available literacy programs lacked engaging content. So they had it, but maybe it didn't really resonate with the students or with the teachers.

And then more than 90% said that they see value in multisensory learning and screen-free options, but they don't always have those resources in their classrooms. So I think these are important, sort of bucket of takeaways is important for literacy champions to keep in mind as we consider how we might partner to improve early literacy. And then I would say the other big bucket of findings was related to the lack of small group support. We know from research that one-on-one and small group instruction are proven methods to help struggling readers, but only about 55% of the teachers surveyed said that they can offer small group instruction and the average amount of time spent on small group instruction and/or one-on-one support each day was less than 30 minutes. I think those are pretty impressive in terms of looking at needs and looking at opportunities. To me, those are the big takeaways, the big picture highlights. But Carol, anyone who wants to take a deeper dive can check out the executive summary of the poll and its findings, which we can include in the show notes.

Carol Vassar, podcast host/producer:

We'll definitely do that. So you've given me some key takeaways. Where do you go next, and what can early literacy champions from across the country do who may be feeling unsupported in terms of finances, in terms of curriculum, in terms of one-on-one support, Kate?

Kate Blackburn, Nemours Children's Health:

So let's say again, thinking in buckets, speaking in bullet points, I'd say there's really three takeaways. So the first one is that it's really important for all of us to recognize that we can't program our way into better literacy outcomes for entire states or for the nation, no matter how excellent a program is, our curriculum is in its ability to improve the scores of a particular child or even a classroom of children, no matter how great it is, moving the needle and improving literacy scores for whole states or the country is also going to require policy and systems changes at the local level, the state level, the federal level. So I think that's like one big bucket that we're going to have to collaborate to look at with our partners that are focused on federal affairs, state affairs, school boards, all of that kind of stuff, and really partner with them and support their goals. 

I would say the second big takeaway bucket is that early literacy champions should seek to tailor their strategies for each of the populations that they serve. So for Nemours, we think about kind of three buckets of populations. We think about our patients, children who reside in our service areas, whether there are patients or not, and then children across the country. A great example of how we have strategized to improve early literacy skills for our patients, Dr. Grysko, she's got a great example of stuff that she's leading personally.

Dr. Rebeca Grysko, Nemours Children's Health:

Thank you, Kate. I can talk a little bit about the work that we do within our hospital school program at Nemours Children's Hospital, Florida. Children with chronic and complex medical conditions face really unique challenges that put them at significant risks for poor academic performance. And literacy is often one of the first areas to be impacted. Frequent hospitalizations, prolonged absences from school, cognitive effects due to treatment, and emotional stress can all disrupt a child's ability to build and maintain strong reading skills. But hospital-based school programs like the programs at both of our children's hospitals offer a really powerful solution. By bringing education directly into the healthcare setting, these programs ensure that learning does not stop when a child becomes seriously ill. Hospital teachers like myself who understand both the medical and academic needs of their students can provide individualized instruction, help maintain grade-level skills, and embed literacy-rich experiences into the child's daily routine.

In short, hospital-based school programs are not just about preventing students from falling behind. They are about giving medically complex children equitable access to learning, supporting their cognitive recovery, and also building a foundation for lifelong learning. At Nemours Children's Hospital in Florida, we are committed to expanding and strengthening our hospital school program to better meet the evolving needs of our patients. This includes expanding access to certified educators across additional inpatient units and outpatient clinics. We are integrating targeted reading interventions for children identified as struggling readers, and also deepening our partnerships with our local schools and districts to help create seamless transition pathways for children that are returning to school after treatment.

Carol Vassar, podcast host/producer:

Dr. Rebecca Grysko is a special education teacher and school liaison at Nemours Children's Hospital, Florida. We also learned more from a very high level about the topic of children's literacy with Kate Blackburn, director of National Practice and Prevention at Nemours Children's Health.

Thanks to Kate and Becca for being on the podcast today. And thank you for listening. Now that we know the issues that surround childhood literacy today, we'll talk next time about one of the solutions, Reading Bright Start, a program designed and proven to ensure that every child is on track to be a capable reader and a healthier member of society. That's next time on the Nemours Well Beyond Medicine Podcast. 

Missed an episode? It's always available to you on our website, NemoursWellBeyond.org. Or you can check out your favorite podcast app and the Nemours YouTube channel to find earlier episodes. If you go to the website, though, you'll find a few other treasures, including a place to leave a review, a voicemail with episode ideas, and even sign-up for our newsletter. Again, that's Nemourswellbeyond.org. Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, and Steve Savino. I'm Carol Vassar. Until next time, remember, we can change children's health for good. Well Beyond Medicine.